KING FERRY, N.Y. — It’s an unlikely place to launch a war against the nursing home industry.
But here on the black-stone edge of a gloomy Cayuga Lake stood the pioneering geriatrician Dr. Bill Thomas, a few feet away from his weapon of choice in this battle: a 330-square-foot, plywood-boned home he calls a Minka.
“I spent my career trying to change the nursing home industry,” he said. “But I’ve come to realize it’s not really going to change. So now what I’ve got to do is make it so people don’t need nursing homes in the first place. That what this is about.”
The idea sounds, in one sense, simple: create and market small, senior-friendly houses like this one and sell them for around $75,000, clustered like mushrooms in tight groups or tucked onto a homeowner’s existing property so caregivers or children can occupy the larger house and help when needed.
Thomas wants to help people grow older on their own turf and terms, while helping spare them the fiscal and physical stress of maintaining bigger homes.
In so doing, he hopes to shield them from the mouth of a funnel that too often summons elders to a grim march — from independent living, to assisted living, to nursing homes, to memory units, and to the grave.
The initiative has turned Thomas into a rare breed: the physician homebuilder, and it pits him not only against the nursing home industry, but also the housing industry, with its proclivity for bigger and bigger spaces.
He faces a steep climb, said James Knickman, an economist and chairman of the National Council on Aging. But he applauds Thomas’s move.
“Whatever Bill comes up with is really different and interesting and usually very insightful, and there’s a lot here that’s interesting,” Knickman said, before pausing. “Sometimes his ideas are difficult to implement. They’re out there a little.”
The Minka initiative, Knickman and others said, is no different.
Thomas, who is 58 with thick black hair, a graying beard, and the build of a former lineman, steps inside the doorway of his first Minka and leans against the kitchen counter as a visitor peeks around.
The structure is warm, light, and surprisingly roomy, in a studio loft sort of way. Four oversize windows look out onto the lake, a shed-style roof rising to the view. (The term “Minka” has Japanese origins, as a traditional house for rural dwellers, typically those of modest financial means.)
In the back corner, across from a big bathroom compliant with the Americans with Disabilities Act, sits a full-size bed. On the other side of a plumbing-filled wall from the bathroom is a kitchen and countertop, made from Ikea components.
The front half of the room feels separate from the back, with a couch that opens to a queen bed and a table that can fit three or four people. And while it looks tiny from the outside, Thomas bristles at the notion that this is a tiny house.
“Tiny houses are terrible for older people,” he grumbled, conjuring images of people with physical or cognitive limitations ascending steep staircases, or hoisting Murphy beds into place, or tracking the hidden storage areas that feature prominently in tiny home designs.
Aside from the ADA-compliant bathroom and lack of stairs, his Minka design is elder-friendly in other ways. On the ceiling is a detachable mechanical lift, to help people get out of bed and move more safely in the bathroom.
And since it’s small, it is easy to clean and cheap to heat and cool.
After a short visit, Thomas takes his visitor on an hourlong drive through the outskirts of Ithaca, through farmland and low-slung commercial areas and, finally, to Owego, a riverside town that thrived during IBM’s birth nearby but now feels like a throwback to the 1970s.
Here, in a building that once housed the D&B auto repair shop, is where Minkas are born. It is also where the economic and logistical complexities of Thomas’s project come into clearer relief.
Thomas dons a pair of yellow noise-canceling headphones to squelch the din of a computer-controlled router commonly known as a CNC machine. The air is chilly in this part of the building, which is separated from the street by thin garage doors.
Using code created by Thomas’s 27-year-old son, Zachary, who commands a computer terminal against a far wall, the CNC turns a standard sheet of three-quarter-inch plywood into the makings of a support beam —one of 15 load-bearing components for a standard Minka.
The sheet takes about a half-hour to cut. To produce the rest of a Minka’s 2,772 pieces, the CNC would toil for 24 hours over a span of two weeks, as a pair of workers assembled the roughly 120 components. A team of three workers would need two days to assemble those parts into a solid, weatherproof structure lined with foam board insulation.
Outside contractors pour the slab, wire the unit, and apply siding and roof shingles. In all, Thomas said the Minka could be move-in ready in two weeks.
Where do Minkas go? It depends. On many things.
Thomas’s primary strategy is to build them in clusters, which provide built-in community and offer economies of scale to builders. In some cases, they could also be built on a homeowner’s existing property, but that could involve the added hassle and expense of a local zoning board appeal for many would-be occupants.
Thomas has at least two community projects in the works, including a 20-Minka cluster in Owego, on a small patch of land a few blocks away from his shop. In gaining regulatory approvals for that plan, Thomas enjoys help from his sister, LeeAnn Tinney, Tioga County’s director of economic development and planning. Owego is the Tioga County seat, and the Thomas family lived a few minutes’ drive from downtown.
The Minkas would be open to people of all ages, Tinney said, but since the homes are poorly suited to people with children, they’ll likely be claimed by retirees and perhaps young professionals.
That sort of mix could characterize another upcoming Minka project, at the University of Southern Indiana, in Evansville, where Thomas will build an as-yet-undetermined number of Minkas. The university is expected to offer more details in a formal announcement in January.
Thomas said these structures, like most first-generation Minkas, will follow a similar design, though future owners could add components “like a Lego house.” Given the still-precarious economics of the business, though, standardization trumps customization for now.
A Minka costs around $200 per square foot to build, which is roughly $25 more than most builders would charge for a conventionally built structure. Thomas said he’ll refine the manufacturing process until he gets the cost to $150 per square foot, to attract local homebuilders to either buy prebuilt Minka kits or customized CNC machines to produce their own.
Minka is a for-profit business, but Thomas said he’s less interested in growing wealthy from the idea than in changing the culture of senior housing. Beyond Minka kits, Thomas will sell additional technologies, tools, and services that, he said, are aimed at helping Minka owners retain their independence.
Those ancillary services and technologies are now in development with companies he described as national corporate partners, and he declined to disclose specifics. But Thomas said the plans lean heavily in the direction of enabling technologies, not entertainment gadgets like robotic dog companions.
For services, he will focus on social engagement, healthy eating, and physical activity.
“If you measure people’s level of disability, it’s a combination of their ability, their environment, and their expectations,” he said. “We think a lot of people’s expectations as they age are tied to the idea of decline, and so they live with less ability than they truly have. We want to challenge that.”
The Minka initiative traces yet another unconventional turn in Thomas’s medical career, which started at Harvard Medical School in the 1980s. Early in his practice, he took shifts at a nearby nursing home.
Not long after, he heard of grant money available to those with ideas for nursing home innovations, and pitched what he now calls an “obvious” idea: bringing plants, animals, and children into the nursing home environment. The grant was funded, and Thomas and his future wife, Jude, built the idea into a movement they called the “Eden Alternative.”
Many of the country’s more innovative nursing homes followed Eden’s resident-centric approach to design and services, and they warmed, too, to Bill and Jude Thomas’s follow-up project, the “Green House” initiative, in which long-term care residents live in cottages with private rooms and private baths, and can choose when to eat.
Thomas’s most recent pre-Minka effort, though, was his most unconventional: a 125-city tour of what he called a “nonfiction theater” troupe, titled “ChangingAging.” Thomas played guitar and sang — not well, he said — alongside professional musicians, clinicians, and others, in a performance meant to challenge assumptions around aging and risk-taking.
After one performance, near Boston in late 2015, he sat with local members of the senior housing community who described elements of what they believed would be an ideal living environment as they grew older.
Small, simple houses. Maybe built on property they already owned, so their children could live nearby.
“I thought it was a performance tour,” Thomas said. “I didn’t know that it was really a listening tour.”
Thomas said Minka will be his final project, and he betrays more than a little regret that it took him this long to come up with the idea.
“We don’t have this data yet, but it will come: We will show that people who are relieved of the burden of a house, and who keep their community and family and friends and social connections will do way better than people who are put in a facility somewhere,” he said.
Even some of his most ardent supporters in the industry aren’t at all convinced the idea has a future.
Margaret Calkins, executive director of the Mayer-Rothschild Foundation, which supports long-term care innovations, said Minka represents “the repackaging of existing ideas,” most notably the “echo housing” concept of building in-law apartments onto one’s home.
Her biggest complaint, though, is that “a very small percentage of people will be interested in a tiny house. They still equate size and square footage with prestige. So I think this idea is a little like the Green House market: People who get it are passionate about it, but it’s a pretty small niche.”
Thomas said it’s easy to keep his expectations measured, largely because of perspective he’s gained from his daughters Hanna and Haleigh Jane, who were both born with a neurological disorder that rendered them unable to speak since birth.
The condition, Ohtahara syndrome, results in multiple seizures daily, any one of which can be fatal. Hannah died in 2015 at the age of 18, and Haleigh Jane, who is 23, lives with her parents and 24-hour caregivers.
Even though Haleigh Jane cannot speak or communicate with her hands, she understands what people are saying. She smiles at the sound of her favorite music; she laughs when her dad and her brothers wrestle with her; she wept when the Harry Potter character Dumbledore died.
The Thomases refer to her as their elder and their teacher. In that respect, Haleigh Jane is, in a way, representative of the community they have long served: frequently wise, but often overlooked or underestimated by outsiders.
It is perhaps not a coincidence, then, that the Minka on Lake Cayuga is known as Haleigh Jane’s house, and is where she lives with her caregivers when the family is at their cottage behind her place.
“I said, if I can make a Minka for her, since she is like the pro at showing us what needs to happen to support someone living with really advanced frailty, I can make it for anyone.”
Would he have arrived at that eventually, without her?
“It’s hard to say. One of the really great things about Haleigh — and this is something I’ll just skim by because otherwise I’ll lose it — but she removed any illusions of invulnerability Jude and I may have had. She and Hannah both. And when you take away the illusion of invulnerability, you find you’re a very vulnerable being. And it gives you a lot more insight into the people and world around you.
“The reason a lot of rich powerful people are such assholes is that they are cloaked in this illusion of invulnerability, and it really makes them jerks. I’m not saying I’m not a jerk, but I am saying that with Haleigh and Hanna I saw just how out of control in this world I really am.”